FREE Hospice and Palliative Nurse Guide Questions and Answers
Nearly all people with amyotrophic lateral sclerosis (ALS) in its last stages:
Deep muscle weakness in the last stages of amyotrophic lateral sclerosis (ALS) prevents patients from breathing on their own; instead, they need mechanical ventilation. A voluntary statement stating that they do not want to be put on a ventilator is signed by some patients. As the disease progresses, some ALS patients may show symptoms of dementia. Patients often lose weight as their swallowing and chewing become more challenging. Early in the course of the disease, slurred speech is common.
Fentanyl patches are used by an ovarian cancer patient to manage their pain. She laments that she is having trouble urinating abruptly and that she is only dribbling little amounts. The patient has bilateral flank pain, but there is no dilation of the bladder. She's not feverish. There is a mild hyperkalemia in her electrolyte count. The most plausible reason is:
Lack of bladder distention and pain in the flank regions indicate that the source of the urine retention is an occlusion of the upper urinary system brought on by the ovarian cancer's spread. If there is blockage in the ureters and If the patient's urine cannot empty, they will experience uremia, which is linked to hyperkalemia. Along with The bladder should fill whether it's due to an opioid-induced shortage of detrusor muscle contractions or a bladder infection. regularly and enlarge, with the suprapubic region typically experiencing pain.
The implementation of advance instructions occurs when a patient:
The process of advance care planning involves cooperation between patients, families, and healthcare professionals through which the Patients make decisions about their future medical therapies (Moore, 2007). Individuals can communicate their advance instructions via the creation of a living will or by naming a representative with medical authority (Wright, 2017). Advance directives only serve as a guide for patient care when are incapable of speaking or choosing for themselves.
A 1.5-inch foam overlay covers the mattress of a bedridden patient. When the nurse puts her palm beneath the overlay, she discovers that it has crushed to a depth of 0.75 inches. This suggests:
When in use, support surface material should offer at least one inch of support beneath regions that will be safeguarded; if the material has bottomed down, there is less than an inch of support. Examine the assistance To assess the amount of support in the area where the patient has a pressure ulcer, slide your palm below the overlay. Patients who are able to shift positions without putting more pressure on their ulcers should use static support surfaces. For people who require aid moving or when static pressure devices only offer a few inches of support, dynamic support surfaces are ideal.
Myelosuppression has occurred in a patient receiving chemotherapy in palliative care urged to stay away from everything listed here, with the exception of:
A high-protein diet is recommended because myelosuppression, or a decrease in bone marrow function, can lead to anemia, which increases the risk of insufficient oxygen delivery to tissues. Other side effects of myelosuppression include thrombocytopenia, or a drop in the quantity of platelets in the blood, which raises the risk of bleeding, and neutropenia, or a decrease in the white blood cells known as neutrophils, which raises the risk of infection. Patients should abstain from any activities that could strain their bodies or cause difficulties. Consequently, one should abstain from alcohol consumption, shaving, and physical activities. The The type of chemotherapy agent employed determines the degree of myelosuppression. As an illustration, Neutropenia is a side effect of irinotecan (used to treat colon and rectal cancer), whereas fluorouracil causes inhibition of platelets, white blood cells, and red blood cells.
Which medication is classified as a very fast-acting, short-acting benzodiazepine and is used for terminal sedation?
For terminal sedation, midazolam is a highly fast-acting, short-acting benzodiazepine. It can be injected subcutaneously or intravenously. Propofol is an anesthetic drug with a relatively rapid onset that requires continuous intravenous (IV) infusion, whereas pentobarbital is a long-acting barbiturate that is delivered subcutaneously or intravenously. One can inject lorazepam, a short-acting benzodiazepine, subcutaneously, intravenously, or buccally. When a patient experiences severe symptoms that are not improving, such as seizures, persistent pain, extreme nausea and vomiting, or a feeling of suffocation, terminal sedation may be necessary.
"Mrs. Alvarez, a patient 67 years of age, has stage 4 lung disease that is chronically obstructive (COPD) as in addition to high blood pressure, high cholesterol, and type 2 diabetes. She is observable in the palliative care clinic for a recheck appointment. Via interpreter, she reports that she is experiencing dull discomfort in a 6 out of 10 on her chest that shines through the nurse is aware that the patient's right shoulder blade, The kind of suffering Mrs. Alvarez is speaking of is?
When will her recently deceased grandmother return, wonders a 4-year-old child. Her mother clarifies as follows: She is unable to return. The young person nods, but subsequently poses the same query. As an illustration, consider this as:
A 4-year-old's grieving responses include looking for the dead, having dreams about the dead, experiencing fear, and apprehensive, desiring to interact socially or closely with loved ones withdrawal, alterations in appetite, irregular sleep schedules, and regression. Suitable therapies for a child aged four consist of sticking to a schedule, allocating as much time as feasible with the youngster, speaking quietly and calmly, empowering the young person to communicate through play, elucidating death as a shift, providing little bites and meals and informing them that the departed would not return (As they can not grasp finality, young toddlers may inquire repeatedly (when the lowered will reappear).
The best course of action for bringing down a fever that is higher than 38.8° C (102° F) is:
To treat temperatures exceeding 38.3 C (101 °F), acetaminophen (325-650 mg every 4-6 hours) or ibuprofen (200-800 mg every 4 hours) are frequently utilized. Because of the potential for negative effects, aspirin is not advised for the treatment of fever. Baths with alcohol are no longer advised and are to be avoided. Shivering and discomfort in the patient may intensify after a cold bath. If medication is not working to lower a high temperature, taking a bath in lukewarm water could help. Hydration is also crucial since increased temperatures can sometimes be a sign of dehydration.
A patient's sole experience with opioid use isnot grow accustomed to it.
Opioids impair intestinal and stomach motility, which results in diarrhea. The body is unable to tolerate this side impact. Some patients may experience constipation that is so bad that they give up using opioids. Consequently, it's imperative that establish a bowel routine for each patient using opioids, This ought to contain a stool softener (to raise the water content of feces) and a laxative to relieve opioid-induced constipation diarrhea. An agonist of the opioid receptor is ethylnaltrexone. This indicates that it prevents pioids' actions in the digestive system, but not the opioid's analgesic properties. It can be injected subcutaneously or taken orally. (To make more digestive motion). Occasionally, a prescription drug, such as Relistor, methylnaltrexone, can be required.
Which of these services is not included in the Medicare Benefit for Hospice?
In2015, the Centers for Medicare & Medicaid Services provided an overview. the services provided by the hospice team members, encompassing medical social services, nursing, medicine, and hospice housewife, caregiver, and occupational, physical, or speech therapists treatments.